Bright Beginnings Christian Preschool, Maple Grove–Registration Form

Please print. Complete the following information to help us meet your child’s individual needs. This form is confidential and must be kept on file at Bright Beginnings Christian Preschool and will be used by the preschool staff only.

Class Requested: Day(s)______Time ______

Child’s Name (As you want your child to print it)
Last First Middle / Nickname
Birthdate / Child’s Gender
Home Address City State Zip / Home Telephone

Parent/Guardian

/

Mother

/

Father

Name
Home Address
City, State, Zip
Occupation
Employer
Email Address
Home, Work & Cell Telephone / (H) / (W) (C) / (H) / (W) (C)

How can you best be reached when your child is at school? ______

______

Who will usually be bring your child to school? ______

Who will usually be picking your child up at school? ______

Name of all persons authorized to remove your child from Bright Beginnings Christian Preschool:
Name / Telephone / Relationship
Name / Telephone / Relationship
Name / Telephone / Relationship
Name / Telephone / Relationship
Name / Telephone / Relationship
Name of two friends/relatives to call who will assume emergency responsibilities if parents cannot be reached:
Name / Address / Telephone / Relationship
Name / Address / Telephone / Relationship
The following licensed physician is authorized to give emergency care to my child:
Physician’s Name / Address
Telephone / City, State, Zip
Name of Parent’s Insurance Company / Contract No. / Group No.
If unavailable, another licensed physician may treat my child ___ Yes ___ No
The following licensed dentist is authorized to give emergency care to my child:
Dentist’s Name / Address
Telephone / City, State, Zip
Name of Parent’s Insurance Company / Contract No. / Group No.
If unavailable, another licensed dentist may treat my child ___ Yes ___ No
List any of the following your child has or has had:
Physical disabilities (speech, hearing, sight, etc.)
Food allergies
Medical allergies
Childhood diseases
List important people in your child’s life (include siblings and ages):
Name / Relationship / Age if sibling
Name / Relationship / Age if sibling
Name / Relationship / Age if sibling
Name / Relationship / Age if sibling

Are there any family interests that you would like to share at school? (travel, experiences, collections, pets, special

talents or hobbies…) ______

What is your child’s first language? ______Second language? ______

Has your child had their Early Childhood Screening? ______

Has your child had previous group experience and where? ______

What best describes your child? (ie-quiet, friendly, cautious, outgoing, independent…______

How does your child indicate that she/he needs to use the restroom? ______

What kinds of activities does your child enjoy? ______

What hand does your child usually write with? ______Does your child write his/her name? ______

Which district and school will your child be attending kindergarten? ______

What do you want your child to gain from this preschool experience? ______

Signature ______Date ______